I get it, we on the floor don't see what you see- gunshots, knife cuts, fights, rape victims. But you chose that. Nursing is a wide, varied profession and ER is just a piece of it. So you work with firefighters, paramedics, police. Okay. But you're not a firefighter, paramedic or a police officer. You're a nurse. When you call the floor for report and we say we're too busy right now, we'll call you back, please don't call your boss, or the House Supervisor, and tell them we refused report. Again, I get it. Nobody is as busy as you. But we may have had our hands deep in poop, or in the middle of a dressing change, or with a doctor, or administering chemotherapy. Or we may be already getting report from the offgoing shift. And yes, another nurse is just as busy and can't take the report I would rather get first hand anyway. When we get report from you for a hip fracture patient and you say the BP is 191/92 and she has a history of hypertension, please don't get offended if I ask if you've covered the blood pressure. I know she's being admitted with a hip fracture and not for hypertension. But hypertension is something we're aware of, because it is also bad. If you send the patient up without covering the BP, by the time she's moved from gurney to bed that BP has spiked to over 200 and I have a possible stroke to add to that fracture. Will it kill you to walk over to your MD, the one with whom you enjoy a closer relationship, and ask for some Vasotec? And while you're at it, could you not forget some pain meds before you send the patient to the floor? You see, I have to call the admitting MD, that very MD your doctor just spoke with to admit the patient, and wait until he calls back, before I can give any medications. That can and does take hours. Meanwhile I have an increasingly uncomfortable, unstable patient and a family who is getting very concerned that this new nurse can't help their mother.
I'm sorry for the long post, but I just read another Megalomaniac ER blog slamming floor nurses as stupid and lazy, refusing report, fighting with ER because they're uncomfortable taking unstable patients ER wants to move because they need the beds. There is more than just you, ER.
For a pt who does NOT have chest pain and is not a trauma/mechanically ventilated and HAS decent veins that Mr Magoo(and for those who are too young to know who Mr Magoo is, he was a blind cartoon character from the 1970's) could cannulate, does the IV HAVE to be in the AC? Just sayin......
Yes, I remember Mr. Magoo! Haven't thought about him in a long time.
Where I work, we hang a lot of liters of NSS wide open by gravity, and they tend to flow better into the bigger AC veins. Patients with fire hoses for veins are not the norm. I wish they were! That would make my life (and theirs) so much easier. But usually, they're either LOLs with those teeny spidery delicate little veins that blow when you poke them with so much as a 24, people with sclerotic veins from history of chemotherapy, IVDA, or PVD, morbidly obese people whose veins are so deep that you can't even palpate them, people who are so dehydrated that their normally big fat veins are flat, etc. Typically we're so busy that we don't have time to futz around looking for the most distal site so as not to inconvenience the floor nurse. We need access and we need it now, and usually the AC is just the quickest, easiest access. I know it's a PITA for the floor nurse, and I used to curse the ED nurses too, when I worked the floor. But now that I'm on the other side of the coin....
More often than not though, I have to pull the report out of the ER nurses at my facility almost EVERY time. So are they ALL having a 'bad day' EVERY day?? I have to ask for a set of vitals...I have to ask about their labs but don't need a whole run-down, just want to know abnormals. I have to ask for an assessment of the presenting problem system. I don't think any of that is being 'hung up on details' but generally the basics so I know what to have ready in the pt's room BEFORE he/she arrives to the unit.
Hmm, I don't know what's wrong with your ED if you're not getting the most recent set of vitals, abnormal labs, an assessment of the system affected by the chief complaint, what meds have been given in the ED, what diagnostic imaging has been done, and maybe even a heads up on any STAT orders to be done on the floor. That's a basic report, IMO. I also like to throw in psych/social stuff if it's relevant, and whatever other details I think the receiving nurse might appreciate. We're even responsible for doing the med rec in my ED. I hear your frustration.
In the ER every situation has to be treated like an emergency. The very second they decide to relax and feel like something is routine, somebody dies. In the ICU every detail is important because you never know what will be the "key" to the puzzle. (if you work MICU you know what I mean) Take too long in figuring out the puzzle, somebody dies. It's critical care at its finest. ER ICU doesn't matter it's just different stages of the game. When I have floated to ER, I had a great time. Some people in both units let the Critical Care aspect go to their heads. They come to believe they are above certain things or perhaps they "know" too much. Either way, I know floor nurses that will work cirlces around people from either unit. It's just people, and some of them ain't that great! Let it go. If we have to make each other feel bad in order to feel good ourselves, that is pretty ****ing pathetic. The patient is what's important. So easy to forget that when our little personal world is disrupted.
I know it's a PITA for the floor nurse, and I used to curse the ED nurses too,
Hmm, I don't know what's wrong with your ED if you're not getting the most recent set of vitals, abnormal labs, an assessment of the system affected by the chief complaint, what meds have been given in the ED, what diagnostic imaging has been done, and maybe even a heads up on any STAT orders to be done on the floor. That's a basic report, IMO. I also like to throw in psych/social stuff if it's relevant, and whatever other details I think the receiving nurse might appreciate. We're even responsible for doing the med rec in my ED. I hear your frustration
Yes it's frustrating but I'm used to it by now but it doesn't mean I like it. I've reported my concerns to the nursing supervisor and she just shrugs her shoulders and says it's not ICU. ER IS a critical care area last time I checked. Makes me wonder though about those ER nurses that's for sure.
Five&Two Will Do said:
Some people in both units let the Critical Care aspect go to their heads. They come to believe they are above certain things or perhaps they "know" too much. Either way, I know floor nurses that will work cirlces around people from either unit. It's just people, and some of them ain't that great! Let it go. If we have to make each other feel bad in order to feel good ourselves, that is pretty ****ing pathetic. The patient is what's important. So easy to forget that when our little personal world is disrupted.
I never make the ER nurses feel bad as in I never say anything rude. Just venting my frustrations here where there ARE other nurses who understand. Get fed up with the ER at my facility being allowed to get away with giving me poor report or telling me that the pt is stable but when they ride up the elevator and I hook em up to my monitor, I find the pt's in rapid A-fib w/RVR and also in flash Pulm edema yet I was told in the report from the ER nurse that the pt was NSR and stable...uh, no they aren't and I highly doubt the pt became unstable in the 10 min it took to get them from the ER to the ICU.
OR when they send me up a patient that's still fully clothed because they didn't want to deal with making the patient put on a hospital gown. Thanks for putting in that foley but how about removing the patients jeans first instead of just unzipping his pants and pulling his member out through the hole and putting that foley in. YES that REALLY did happen once. Some things just can't be made up!
Yes it's frustrating but I'm used to it by now but it doesn't mean I like it. I've reported my concerns to the nursing supervisor and she just shrugs her shoulders and says it's not ICU. ER IS a critical care area last time I checked. Makes me wonder though about those ER nurses that's for sure.
Five&Two Will Do said:
I never make the ER nurses feel bad as in I never say anything rude. Just venting my frustrations here where there ARE other nurses who understand. Get fed up with the ER at my facility being allowed to get away with giving me poor report or telling me that the pt is stable but when they ride up the elevator and I hook em up to my monitor, I find the pt's in rapid A-fib w/RVR and also in flash Pulm edema yet I was told in the report from the ER nurse that the pt was NSR and stable...uh, no they aren't and I highly doubt the pt became unstable in the 10 min it took to get them from the ER to the ICU.
OR when they send me up a patient that's still fully clothed because they didn't want to deal with making the patient put on a hospital gown. Thanks for putting in that foley but how about removing the patients jeans first instead of just unzipping his pants and pulling his member out through the hole and putting that foley in. YES that REALLY did happen once. Some things just can't be made up!
I actually laughed out loud when I read the last one! I am sorry and I do get what you are talking about cause it does happen here too. Well not that last one, but a lot of the things you have written in you other posts have happened. I do not understand it anymore than you and I hope I did not come across in any sort of condescending fashion. What I said is how I feel about the whole issues between units. If everyone would keep the patient first and put their differences aside, it would go a lot smoother. The flash pulmonary edema part scares the crap out of me. Not always an abundance of time with that one!
Nope and I highly doubt the pt JUST went into flash pulm edema the instant he arrived into ICU.
Getting a decent report on a new admission IS all about patient care. Lots of times I don't have time to peruse the chart to glean pertinent information upon arrival. Frequently, they 'forgot' to tell me something that I need to know which could be detrimental to the care of my patient.
Nope and I highly doubt the pt JUST went into flash pulm edema the instant he arrived into ICU.
Getting a decent report on a new admission IS all about patient care. Lots of times I don't have time to peruse the chart to glean pertinent information upon arrival. Frequently, they 'forgot' to tell me something that I need to know which could be detrimental to the care of my patient.
Yes this is a good point that you make. What I do not understand, nor do patients, is why they can sit in the ER for hours and hours, and then when it is finally time to admit them, it has to be done right away?
Yes this is a good point that you make. What I do not understand, nor do patients, is why they can sit in the ER for hours and hours, and then when it is finally time to admit them, it has to be done right away?
Because the lobby is full of people waiting to be seen, and you never know who is actually having a medical emergency. If you think about it, with a lobby packed with anywhere from 25-50 people, that's a nurse to patient ratio of 1:25-50 for the triage nurse. It's a very dangerous situation. People have died waiting in ER lobbies. On top of that, you have ambulances arriving every five minutes, and you're triaging on arrival based upon chief complaint, vital signs, symptoms, etc. That patient arriving by ambulance could be stable and able to wait, or they could be really sick and you have to drop everything else to focus on them. We absolutely HAVE TO keep the patient flow going. It's a core part of ED nursing.
Imagine it from the patient's point of view. You've been in the ED for six hours on the hard, narrow stretcher, feeling horrible, watching bloody people, screaming people, puking people, roll by your room. You're hearing babies screaming, mentally ill people yelling and banging their heads on the wall, your back is killing you from the stretcher and you're starving. Wouldn't you want to get out of there the second you got a bed assignment? Now imagine you finally make it to your assigned room, and the nurse receiving you has an attitude.
At MY hospital the Dr's(usually DO's) would rather NOT take the elevator up to ICU on the 2nd floor. Why? I dunno. Laziness.
As for the guy with garden hoses for veins...we don't have a cath lab in house for emergencies so if a pt does have to have a cath, they get shipped to the Heart Center down the street. My ER doesn't do anything in triage other than take a quick history and a set of vitals...any procedure, like putting in an IV gets done if needed when the pt is brought back to a bed for further work-up.
All I'm saying is that if a patient has decent veins as stated in my example, the AC shouldn't be the FIRST place to insert an IV, from what I was taught.
If someone is suspected of possibly, maybe, might just end up needing a cath lab intervention (even if it's at another hospital), they should get TWO IVs in the AC. That's standard operating procedure just about everywhere.
I don't know who taught you that an AC vein isn't the first place to go for an MI intervention. It absolutely should be.
Because the lobby is full of people waiting to be seen, and you never know who is actually having a medical emergency. If you think about it, with a lobby packed with anywhere from 25-50 people, that's a nurse to patient ratio of 1:25-50 for the triage nurse. It's a very dangerous situation. People have died waiting in ER lobbies. On top of that, you have ambulances arriving every five minutes, and you're triaging on arrival based upon chief complaint, vital signs, symptoms, etc. That patient arriving by ambulance could be stable and able to wait, or they could be really sick and you have to drop everything else to focus on them. We absolutely HAVE TO keep the patient flow going. It's a core part of ED nursing.
Imagine it from the patient's point of view. You've been in the ED for six hours on the hard, narrow stretcher, feeling horrible, watching bloody people, screaming people, puking people, roll by your room. You're hearing babies screaming, mentally ill people yelling and banging their heads on the wall, your back is killing you from the stretcher and you're starving. Wouldn't you want to get out of there the second you got a bed assignment? Now imagine you finally make it to your assigned room, and the nurse receiving you has an attitude.
I never have an attitude with my patients, I was simply asking why is it that it takes forever to get them through the ER and then when they finally are to be admitted it HAS TO BE RIGHT NOW? Honest question that you answered sufficiently. I have never had attitude about taking another patient, and perhaps that is why I have moved on to critical care so quickly. I actually like my job unlike some of my peers and a lot of the people on this site.
Because the lobby is full of people waiting to be seen, and you never know who is actually having a medical emergency. If you think about it, with a lobby packed with anywhere from 25-50 people, that's a nurse to patient ratio of 1:25-50 for the triage nurse. It's a very dangerous situation. People have died waiting in ER lobbies. On top of that, you have ambulances arriving every five minutes, and you're triaging on arrival based upon chief complaint, vital signs, symptoms, etc. That patient arriving by ambulance could be stable and able to wait, or they could be really sick and you have to drop everything else to focus on them. We absolutely HAVE TO keep the patient flow going. It's a core part of ED nursing.
Imagine it from the patient's point of view. You've been in the ED for six hours on the hard, narrow stretcher, feeling horrible, watching bloody people, screaming people, puking people, roll by your room. You're hearing babies screaming, mentally ill people yelling and banging their heads on the wall, your back is killing you from the stretcher and you're starving. Wouldn't you want to get out of there the second you got a bed assignment? Now imagine you finally make it to your assigned room, and the nurse receiving you has an attitude.
And another thing I wonder, I have been to the ER here and sometimes, especially on weekends, it is quite busy. Other times it is not. Perhaps you work in a major metro area where the ER is constantly backed up with 50 people waiting to be seen, but that is not the case in many places.
I hear your frustration.
I am sorry and I do get what you are talking about cause it does happen here too. Well not that last one, but a lot of the things you have written in you other posts have happened. I do not understand it anymore than you and I hope I did not come across in any sort of condescending fashion. What I said is how I feel about the whole issues between units. If everyone would keep the patient first and put their differences aside, it would go a lot smoother. The flash pulmonary edema part scares the crap out of me. Not always an abundance of time with that one!
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
Yes, I remember Mr. Magoo! Haven't thought about him in a long time.
Where I work, we hang a lot of liters of NSS wide open by gravity, and they tend to flow better into the bigger AC veins. Patients with fire hoses for veins are not the norm. I wish they were! That would make my life (and theirs) so much easier. But usually, they're either LOLs with those teeny spidery delicate little veins that blow when you poke them with so much as a 24, people with sclerotic veins from history of chemotherapy, IVDA, or PVD, morbidly obese people whose veins are so deep that you can't even palpate them, people who are so dehydrated that their normally big fat veins are flat, etc. Typically we're so busy that we don't have time to futz around looking for the most distal site so as not to inconvenience the floor nurse. We need access and we need it now, and usually the AC is just the quickest, easiest access. I know it's a PITA for the floor nurse, and I used to curse the ED nurses too, when I worked the floor. But now that I'm on the other side of the coin....